I’ve been getting lots of great emails with questions recently, and will try to get to as many as possible. Here is one from this morning.
Hi Dr. Burns,
I really hope you get to see this! I just wanted to say how I love your book and it has been helping me a lot I bought and read Feeling Good: The New Mood Therapy, and I’m currently reading your book on anxiety, When Panic Attacks.
But I did want to say one thing. On page 216, near the bottom, it says, ” … in fact, we’re all defective and you can view your ‘defectiveness’ as a reason for suicide or a cause for a celebration….”
I didn’t understand that. That we should view us being defective as a reason to kill ourselves?? It threw me off and I asked my friend to read it over. I just want to know what you meant!
It’s near the bottom second to last paragraph on page 216
Sometimes I write things that may be hard to “get” at first, so I appreciate your question. First, let me emphasize that suicide is never appropriate or needed for someone who is feeling depressed and hopeless. However, was writing about something I call the Acceptance Paradox, where you achieve enlightenment by accepting your many shortcomings with a sense of inner peace, or even with a sense of humor. I call that “healthy acceptance.”
And when you “grasp” this notion that it is okay to be flawed and defective, or even wonderful, you can achieve liberation from feelings of depression, anxiety, shame and self-doubt. And it brings you a lot closer to other people, too, because, believe me, there are TONS of other defective people out there, so we can have a party and lots of folks will join us, and we can just hang out and not worry about having to impress each other.
But people who are depressed usually have what I call unhealthy acceptance. They wrongly believe that because they are defective, they should kill themselves.
If you CLICK HERE, you will find a chart that distinguishes healthy from unhealthy acceptance. As you can see, healthy acceptance is characterized by joy, intimacy, laughter, and creativity. In contrast, unhealthy acceptance is characterized by cynicism, depression, hopelessness, and loneliness.
This is sometimes hard to “see” at first on an emotional level, especially if you are depressed, or prone to depression. But when you suddenly “get it,” it’s like seeing the grand canyon for the first time. It simply takes your breath away, and you discover that it’s only okay to be defective, it’s actually great–in fact, the very BEST way to be!
I am writing something more ambitious on this topic, and I’ll publish it here soon. This is just a beginning note intended to whet your appetite, hopefully at least! What I am writing about now are some of the more philosophical underpinnings of TEAM-CBT, although the notions are actually ancient, and go back at least 2500 years. I will try to address two questions:
Is it possible to be worthwhile or to be worthless?
Do we have a “self”?
Although these themes may seem abstract, they have powerful, practical, emotional consequences. Just one small example, let’s say you struggle with anxiety and shyness. You may have the fear that others will judge you because you are inferior, or not “good enough,” and this thought can cause tremendous suffering. But this thought is based on the notion that you have a “self” that can be evaluated or judged. When you see through this notion, you can experience liberation from your fears.
The Buddhists called this “The Great Death.” Of course, we all fear death, and struggle to keep our egos alive. But once you’ve “died,” so to speak, you can join the Grateful Dead, and then life suddenly opens up in unexpected ways. And for those who may misread me, or interpret my words literally, I am not referring to physical death, but death of the “self.”
So, stay tuned if this type of dialogue interests you! And thanks for reading this!
If you are reading this blog from Facebook or Twitter, I appreciate it! I would like to invite you to visit my website, http://www.feelinggood.com, and register there as well. You will find a wealth of free goodies, including my Feeling Good blogs, plus all my Feeling Good Podcasts to date, and the Ask Dr. David blogs as well, along tons of resources, including videos for mental health professionals as well as patients and the general public!
Do not copy, publish or reproduce without the written permission of Dr. Burns.
Last time we discussed the consequences of therapists’ failure to measure changes in symptoms as well as the quality of the alliance at every session. Today, I’m focusing on another common therapist error you may have never heard of—hypnosis of the therapist by the patient!
We all know that some therapists hypnotize their patients, but I’ll bet you’ve never heard of the reverse type of hypnosis—that’s when the patient hypnotizes the therapist, and the therapist doesn’t even realize that he or she has fallen into a trance. It’s important to know about reverse hypnosis, because it can sabotage the therapy.
Of course, the patient doesn’t dangle a pendulum in front of the therapist while saying “You are getting very sleepy, very sleepy”—but we can sometimes fall into trances without realizing it. And when you are in a trance, you will tend to believe things that are not valid.
There are three common forms of reverse hypnosis:
Depression Hypnosis—depressed patients convince you that they really are hopeless and worthless.
Anxiety Hypnosis—anxious patients convince you that they really are too fragile to confront their fears using exposure techniques.
Relationship Hypnosis—Patients with troubled relationships convince you that their relationship problems really are the other person’s fault and that they really are the victims of the other person’s bad behavior.
Nearly all depressed patients are totally convinced that they are worthless, inferior, or defective. They are usually equally convinced that they are hopeless, that their problems are insoluble, and that they will be miserable forever. If you’ve ever felt depressed, you know how powerful and painful these feelings can be.
The thoughts that generate these demoralizing feelings are nearly always distorted—you may be familiar with the list of ten Cognitive Distortions that I first published in my book Feeling Good. When you fall into the black hole of depression, your thoughts typically involve distortions such as:
All-or-Nothing Thinking—You look at things in black or white categories. If you’re not a complete success, you tell yourself that you’re a total failure.
Overgeneralization—You see a negative event—such as rejection by someone you love, or failure to achieve your goal—as a never-ending pattern of defeat.
Mental Filtering—You focus on some flaw, failure, problem or shortcoming, as if this reflects your entire self. This is like the drop of ink that discolors the beaker of water.
Discounting the Positive—This mental error is even more spectacular. You tell yourself that your good qualities don’t count. In this way, you can maintain the belief that you’re defective, or that you’re a total loser.
Jumping to Conclusions—There are two common forms of this distortion: Fortune Telling involves making dire negative predictions that aren’t warranted by the facts. For example, when you’re depressed you tell yourself that you’re problems are hopeless and that you’ll be miserable forever. Mind-Reading involves telling yourself that others are looking down on you without any good evidence. Shy people do this in social situations, imaging that everyone else feels confident and that everyone can see how anxious and inept they feel.
Magnification and Minimization—Blowing things out of proportion, or shrinking their importance. For example, when you procrastinate you dwell on ALL you have to do (Magnification) and tell yourself that getting started and doing a little bit would just be a drop in the bucket (Minimization).
Emotional Reasoning—This is reasoning from how you feel: “I FEEL worthless (or hopeless), so I must BE worthless (or hopeless).”
Labeling–You label yourself as “lazy” or “a loser,” or you label someone else as “a jerk.”
Overt and Hidden Should Statements—As in, “I SHOULDN’T have made that mistake,” or “I SHOULD be better than I am.” Should Statements directed against yourself trigger feelings of depression, guilt, shame, and inferiority. Should Statements directed against others, or against the world, trigger anger and frustration.
Blame—There are two common varieties. Self-Blame leads to depression, and Other-Blame leads to anger and conflict.
But when you’re feeling depressed, anxious, or angry, you don’t realize that your thoughts are distorted and misleading because they feel and seem overwhelmingly realistic. The goal of Cognitive Therapy is to help the patient put the lie to these distorted thoughts. And the moment you stop believing them, you’ll feel much better.
But here’s the funny thing. Toward the beginning of therapy, I usually buy into the patient’s negative thinking. Patients are extremely good and convincing themselves and others that they really ARE worthless losers who are doomed to lives of mediocrity and misery. So I get panicky for a little while in the first or second session because I start telling myself, “This person really DOES sound like a bit of a worthless loser. Maybe there aren’t any distortions this time!”
I don’t mean to mean to sound cruel or insensitive—it is just that I have fallen into a kind of depressive trance, and most therapists do the same thing. I have bought into the patient’s extremely negative and distorted thinking. You could even think of this hypnotic trance as a form of super-empathy, because the therapist can really SEE the world through the patient’s eyes. The patient’s intensely negative view of himself or herself and the world suddenly seems almost impossible to dispute.
Then, several weeks later, when the patient and I have been working together effectively, and the patient develops the ability to crush the negative thoughts, the patient and I can suddenly see how distorted they were all along. We have both snapped out of the trance, and the patient feels a sudden flood of relief, or even euphoria. At that point, it dawns on me that I had succumbed, once again, to the patient’s depressive hypnosis.
This is not a trivial or rare problem. In fact, therapists are sometimes even trained to buy into the patient’s negative thoughts. At continuing education conferences, for example, therapists might be advised to “educate” patients and their families into believing that the prognosis for depression is guarded, and that while they can be helped somewhat, they may always have to struggle with depression and may need to take antidepressants and other medications indefinitely to correct the “chemical imbalance” in their brains, much as diabetics need to take insulin forever. Or, they may need psychotherapy indefinitely. And, of course, once you give your patients that message, many of them will believe it, and it becomes a self-fulfilling prophecy.
Early in my career, I asked Dr. Aaron Beck, a brilliant pioneer who helped to create and develop cognitive therapy, if some patients REALLY WERE hopeless. He said that he had never once bought into the notion that any depressed patient was hopeless. He said that this optimistic philosophy had worked out well in clinical practice, and that I might have to make a policy decision of my own on whether or not I would buy into that type of thinking.
I settled on the same policy, and it has always paid off for me. I remind myself that no matter how severe or overwhelming the depression might seem, the patient can, in fact, recover and feel joy and self-esteem again. That policy has been invaluable in my clinical work, and it has never let me down.
Of course, the belief alone won’t cure patients. You have to have many good treatment tools to back up your vision.
I could write a chapter or book with examples of rapid recovery in patients who initially seemed hopeless or worthless, but I’ll just give you an extreme and brief one example here. When I was in Philadelphia, we had an intensive program for patients from out of town. The idea was to try to complete an entire course of therapy in a week or even less by seeing patients several hours every day. It was a pretty successful program.
I can recall an incredibly challenging woman named Eve who travelled all the way from Germany for treatment. (I always disguise or change the facts to protect patient identities.) Eve had struggled with intractable depression and OCD for more than 40 years, with no success at all. She’d been treated with every known antidepressant and tons of other drugs, and had been hospitalized on numerous occasions. In addition, she’d received more than 100 ECT (electroconvulsive) treatments. Psychotherapy didn’t work either. Eventually, she was given a frontal lobotomy, but that did not help, either. Two years later, she had a second lobotomy, again with no beneficial effects.
Eve wanted to know if there was any hopeThe situation did not look very promising, to say the least, but I tried to hide my pessimistic feelings. I told Eve that while I couldn’t make any promises, we’d sometimes had surprisingly positive results with even the most severe cases, and that the new treatment techniques that my colleagues and I had developed were definitely worth a try.
I wasn’t able to take her on myself, since my practice was temporarily full, so I referred her to a colleague who was working with me at our clinic. I must confess that I had a sense of relief that I didn’t have to treat. Her situation seemed impossible.
Two days later I asked my colleague how things were going with Eve. He seemed in a surprisingly chipper mood and said that the symptoms of depression and OCD had vanished and that she was feeling happy for the first time in decades. I asked him what in the world he’d done. He said that she was easy to treat and that he just used the same techniques we use all the time, such as the Daily Mood Log, Identify the Distortions, the Paradoxical Double Standard Technique, the Externalization of Voices, the Acceptance Paradox, and several others.
It dawned on me that once again, I had succumbed to a “depressive trance” without realizing it.
Now my colleagues at the Feeling Good Institute in Northern California have created a similar intensive program for people from around the country who want to commute it for short-term treatment. For more information, go to the FeelingGoodInstitute.com website.
Or, to learn more about how to defeat the negative thoughts that trigger depression and anxiety on your own using self-help techniques, check out one of my books, such as Feeling Good.
Thanks for reading this. In my next blog I’ll discuss Reverse Anxiety Hypnosis.